UnitedHealthcare Community Plan for Families Glossary

A

Advance Directive

A decision about your health care that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

ASC/SPU

Ambulatory surgical center/short procedure unit.

Authorization

An O.K. or approval for a service.

B

Benefits

Services, procedures and medications that UnitedHealthcare Community Plan for Kids will cover for you.

C

Clinical Care Management

One-on-one help by a nurse providing education and coordination of UnitedHealthcare Community Plan for Kids benefits, tailored to your needs.

D

Disenrollment

To stop your membership in UnitedHealthcare Community Plan for Kids.

E

Emergency

When you reasonably believe that your health is in serious danger.

F

Fraud

An untruthful act – an example is someone other than you using your UnitedHealthcare Community Plan for Kids member ID card and pretending to be you.

H

Home Health Agency

A company hired by UnitedHealthcare Community Plan for Kids to provide care for you in your home.

I

ID Card

Identification card – a card that says you are a UnitedHealthcare Community Plan for Kids member. You should have this card with you at all times.

M

Medical Necessity

Member

A person who is eligible for UnitedHealthcare Community Plan for Kids.

O

Outpatient

A nonhospitalized patient receiving covered services away from a hospital, such as in a physician's office or the patient’s own home, or in a hospital outpatient or hospital emergency department or surgical center.

P

Primary Care Physician (PCP)

A doctor you choose to be your family physician. They have their own private practices.

Prior Authorization

The process for any service that needs an O.K. from UnitedHealthcare Community Plan before it can take place.

Provider

Any medical professional that UnitedHealthcare Community Plan has contracted with to take care of you.

Provider Directory

A list of providers who participate with UnitedHealthcare Community Plan for Kids to help take care of your healthcare needs.

R

Referral

When you and your primary care provider agree you need to see another doctor, your primary care provider will send you to a UnitedHealthcare Community Plan for Kids specialist.

S

Self-Referred Services

Services for which you do not need to see your primary care provider for a referral.

Special Needs Unit (SNU)

A voluntary service offered by UnitedHealthcare Community Plan for Kids that can give you extra help in understanding and using your benefits if you have a disability or other special need.

Specialist

A doctor that has specific, detailed training in one certain medical field.

T

Treatment

The care that you may receive from doctors and facilities.

U

Urgent Care

When you need care, treatment or medical advice within a 24-hour time period.

W

WIC

Women, Infants and Children program, a supplemental nutrition program that provides nutritious food, education support and health care referrals for women, infants and children.

UnitedHealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call 1-844-812-5967 TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Nurseline Disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected™ for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-844-445-8328 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

UnitedHealthcare Connected™ (Medicare-Medicaid Plan)

UnitedHealthcare Connected (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of Non-English Disclaimer

ATTENTION: If you speak [insert language], language assistance services, free of charge, are available to you. Call 1-844-812-5967 TTY 711.

Star Ratings Disclaimer

Medicare evaluates plans based on a 5-Star rating system.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

NCQA

UnitedHealthcare Connected has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2017 based on a review of UnitedHealthcare Connected’s Model of Care.

Important Provider Information

The Choice is Yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper Directory Requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate Information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UHC Members should call the number on the back of their ID card, and non-UHC members can call 888-638-6613 TTY 711.

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